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Shawna D Nesbitt MD, MS Associate Professor Cardiology Division, - - PowerPoint PPT Presentation
Shawna D Nesbitt MD, MS Associate Professor Cardiology Division, - - PowerPoint PPT Presentation
Shawna D Nesbitt MD, MS Associate Professor Cardiology Division, Hypertension Section Associate Dean of Student Affairs University of Texas Southwestern at Dallas Speakers Bureau: Lundbeck, Amgen Consultant: Lundbeck, Amgen Major Stock
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Present the current epidemiology of
hypertension
Review the core elements of hypertension
diagnosis and classification which are essential to all of the guidelines.
The SPRINT Trial Results and implications for
treatment goals
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*Blood pressure (BP) <140/90 mm Hg in non‐diabetic patients or BP <130/80 in diabetic patients.
† BP <130/80 mm Hg.
Ong KL et al. Hypertension. 2007;49:69‐75. Egan BM JAMA 2010;303:2043 AHA Statistics 2011 Circ 2011;123:e18
Nearly One in Three US adults has Hypertension: Prevalence of 33.5%
20 40 60 80 100 1999-2000 (n=1530) 2001-2002 (n=1500) 2003-2004 (n=1614) 2007-2008 US Population With Hypertension (%)
Awareness Treatment Control (treated)* Control (treated hypertensive diabetics) Control (all with hypertension)*
50%
†
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Roger V Circulation 2011;123:e18
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Blood Pressure (mm Hg) Category Systolic Diastolic <120 and <80 Normal 120-139
- r 80-89
Prehypertension 140-159
- r 90-99
Stage 1 hypertension ≥160
- r ≥100
Stage 2 hypertension
JNC 7 Definitions
Chobanian AV, et al. Hypertension 2003;42:1206‐52
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How did they get there?
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From: 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
- JAMA. 2013;():. doi:10.1001/jama.2013.284427
2014 Hypertension Guideline Management Algorithm. SBP indicates systolic blood pressure; DBP, diastolic blood pressure; ACEI, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; and CCB, calcium channel blocker.a ACEIs and ARBs should not be used in combination.b If blood pressure fails to be maintained at goal, reenter the algorithm where appropriate based on the current individual therapeutic plan.
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Step 4 Aged over 55 years
- r black person of
African or Caribbean family origin of any age Aged under 55 years C2 A A + C2 A + C + D Resistant hypertension A + C + D + consider further diuretic3, 4 or alpha- or beta-blocker5 Consider seeking expert advice Step 1 Step 2 Step 3
Key A: ACEI or low-cost ARB1 C: CCB D: Thiazide-like diuretic NICE Guidelines 2012
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*Up to 3 months of comprehensive lifestyle modification without drugs if BP <145/90 mmHg without target‐organ damage or other risk‐enhancing comorbidities. †Target‐organ damage is defined as albumin:creatinine ratio >200 mg/g, estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, or electro‐ or echocardiographic evidence of left ventricular hypertrophy (LVH). ‡Indicators of preclinical CVD: metabolic syndrome, Framingham risk score >20%, prediabetes (impaired fasting glucose [100‐125 mg/dL] and/or impaired glucose tolerance [2‐hr postload glucose of 140‐199 mg/dL]), diabetes mellitus. §CVD includes heart failure (systolic or diastolic), CHD/post‐myocardial infarction, peripheral arterial disease, stroke, transient ischemic attack, and/or abdominal aortic aneurysm.
Risk Category Recom m endation Goal BP
Prim ary Prevention BP ≥135/85 mmHg without target-organ damage,† preclinical CVD,‡ or CVD§
Lifestyle Modification* (up to 3 months without drugs) + Drug Therapy <135/85 mmHg
Secondary Prevention/ Target-Organ Dam age BP ≥130/80 mmHg with target-organ damage,† preclinical CVD,‡ and/or the presence of CVD§
Lifestyle Modification + Drug Therapy <130/80 mmHg
Hypertension 2010;56:780
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SPRINT TRIAL: Systolic Blood Pressure Intervention Trial
A Randomized Trial of Intensive versus Standard Blood-Pressure Control
N Engl J Med 373(22):2103-2116 November 26, 2015
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The SPRINT Research Group. N Engl J Med 2015;373:2103-2116
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SPRINT TRIAL: Systolic Blood Pressure Trend
The SPRINT Research Group. N Engl J Med 2015;373:2103-2116
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SPRINT Trial: Primary Outcome and Death from Any Cause.
The SPRINT Research Group. N Engl J Med 2015;373:2103-2116
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SPRINT Study Primary Outcome According to Subgroups
The SPRINT Research Group. N Engl J Med 2015;373:2103-2116
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SPRINT Trial: Baseline Characteristics of the Study Participants.
The SPRINT Research Group. N Engl J Med 2015;373:2103-2116
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SPRINT TRIAL: Primary and Secondary Outcomes and Renal Outcomes.
The SPRINT Research Group. N Engl J Med 2015;373:2103-2116
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SPRINT TRIAL: Primary and Secondary Outcomes and Renal Outcomes.
The SPRINT Research Group. N Engl J Med 2015;373:2103-2116
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SPRINT Trial: Serious Adverse Events, Conditions of Interest, and Monitored Clinical Events.
The SPRINT Research Group. N Engl J Med 2015;373:2103-2116
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SPRINT TRIAL CONCLUSION
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Outcomes Data from SPRINT and the ACCORD Trial and Combined Data from Both Trials.
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Stroke CHD Total –6 –4 –3 –8 –5 –4 –14 –9 –7 Reduction in BP
Population‐Based Strategy
SBP Distributions Before Intervention After Intervention
% Reduction in Mortality Reduction in SBP mmHg 2 3 5
SBP<140 SBP<135
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AHA/ACC Hypertension Algorithm. Go A et al Hypertension 2014;63:878‐885
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